title: The arterial blood supply of the human patella. Its clinical importance for the operating technique in vascularized knee joint transplantations.
abstract: The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o'clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.
authors.affiliation: Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University Munich, Germany.
authors.forename: M H
authors.initials: MH
authors.lastname: Kirschner
authors.forename: J
authors.initials: J
authors.lastname: Menck
authors.forename: A
authors.initials: A
authors.lastname: Nerlich
authors.forename: R
authors.initials: R
authors.lastname: Walser
authors.forename: V
authors.initials: V
authors.lastname: Bühren
authors.forename: G O
authors.initials: GO
authors.lastname: Hofmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D001182:Arthroscopy; D001706:Biopsy; D004164:Diphosphonates; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015609:Organotechnetium Compounds; D010329:Patella / Q000098:blood supply* / Q000473:pathology; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
chemical_list: D004164:Diphosphonates; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid